Structural change in Medicare funding: Impact on the dietetics workforce

Aim:  To review the dietetic workforce profile and share of Enhanced Primary Care claims in the context of the Strengthening Medicare support for allied health services.
Methods:  Dietitians Association of Australia membership data from 2004 to 2007 were analysed to assess changes in the number and work hours of private practice dietitians. Medicare data for 2004–2005 to 2006–2007 were reviewed regarding uptake and distribution of allied health consultations.
Results:  The number of allied health Enhanced Primary Care consultations doubled between 2004–2005 and 2005–2006, with similar increases in 2006–2007. Physiotherapists claimed most, followed by podiatrists, then dietitians. Dietitians claimed most consultations per provider in 2004–2005 and 2005–2006, surpassed by podiatrists and diabetes educators in 2006–2007. The number and full-time equivalents of private practice dietitians increased since 2004. Almost one-third of members were engaged in private practice work by 2007. Approximately half of these worked eight hours or fewer per week in this setting over the period surveyed (45.9–50.8%).
Conclusions:  Medicare funding for allied health has provided structural change and presents an opportunity for growth in the private sector of dietetics. While the number and full-time equivalents of private practice dietitians increased since 2004, the anticipated sharp increase relative to other work areas was not seen. Dietetics had a high uptake of Medicare consultations per provider and consultations increased each year; however, the declining share of total consultations demonstrates that dietitians are not using the opportunity presented by Medicare to the same degree as some allied health professions.     

Marketing the dietetics profession to consumers and stakeholders: A social and professional imperative

(Nutr Diet 2005;62:158–160) In the present paper we argue that despite the potential impact of dietetic practice on public health, the use of professional dietetic services appears to be stagnant. To redress this position, dietitians may need to increase their use of marketing activities to promote the value of the profession. We discuss the different roles of the Dietitians Association of Australia and of individual members in marketing activities, provide an overview of the key components of a marketing plan and strategy, and outline specific steps that dietitians can take to actively promote their services. We argue that promotion of the dietetic profession may ultimately contribute to better health through nutrition for the Australian population.     

Dietetic practice in the management of gestational diabetes mellitus: A survey of Australian dietitians

Aim: To examine current Australian dietetic practice in the management of gestational diabetes, to identify models of dietetic care and to determine the need for national evidence‐based dietetic practice guidelines for gestational diabetes. Methods: A 55‐item cross‐sectional survey of Australian dietitians practicing in the area of gestational diabetes was undertaken. Participants were recruited via Dietitians Association of Australia interest group membership, public and private hospital maternity and diabetes services across Australia. The survey examined dietetic service provision, interventions, management recommendations, postnatal care, current guideline use and the perceived need for Australian evidence‐based dietetic management guidelines. Results: A total of 220 eligible dietitians participated in the survey. The majority (77%) reported that all women with gestational diabetes attending their service were referred to a dietitian. Group (33%) and individual consults (93%) were provided and 67% provided one to two dietetic consults per client. Fifty‐four per cent (54%) believed that their service currently offered adequate antenatal dietetic interventions and 8% adequate postnatal follow up for women with gestational diabetes. There were differences in the implementation of medical nutrition therapy by Australian dietitians in regards to nutrient recommendations. However, consistency was seen in key components of nutrition education. Dietitians perceived that there was a need for evidence‐based gestational diabetes dietetic practice guidelines (86%) and nutrition recommendations (87%). Conclusion: The survey results strongly indicate there is a need for evidence‐based gestational diabetes practice guidelines and nutritional recommendations and provide baseline data for future practice of Australian dietitians working in gestational diabetes.     

Practice Paper of the Academy of Nutrition and Dietetics Abstract: Nutrition Informatics

As valued members and decision makers of the health care team, registered dietitians and dietetic technicians, registered, practice in a wide variety of settings from corporate wellness to the intensive care unit. Each of these work settings has unique information needs, but all require that dietetics practitioners have immediate access to accurate information. Successful dietetics practice in today's rapidly changing environment requires skills in finding, evaluating, and sharing accurate food and nutrition information. The term informatics is used to describe the science of managing, storing, and communicating information. While not required for informatics practice, use of computers greatly facilitates management of large amounts of information. Health informatics focuses on the application of information science within the health care arena. The field of health informatics includes medical, nursing, pharmacy, dental, public health, and now nutrition informatics. Registered dietitians and dietetic technicians, registered, are now creating nutrition informatics as a new area of dietetics practice. Current use of informatics in health care includes electronic health records, outcomes research, and knowledge acquisition.     

The Nutrition Care Process Terminology: Changes in perceptions,attitudes, knowledge and implementation amongst Australian dietitians after three years

Aim

Assessing changes in dietetic perceptions, attitudes and knowledge regarding the Nutrition Care Process Terminology (NCPT) is important to determine implementation effectiveness. This study aimed to investigate changes in the perceptions and attitudes of Australian dietitians over a three‐year period, identify changes in benefits and barriers to support successful NCPT implementation and determine future directions for NCPT progression.

Methods

An online survey was performed in 2011 and repeated in 2014 by recruiting members of the Dietitians Association of Australia (DAA) through an email link. The survey assessed familiarity, knowledge, attitudes, benefits, barriers, concerns and use of educational enablers around the NCPT.

Results

The survey was completed by 218 respondents in 2011 and 205 respondents in 2014. Survey respondents from both years were representative of overall DAA membership. Respondent knowledge of NCPT increased significantly over the three‐years, as did confidence, preparation, access to support and training and NCPT usage. Respondent's identification of benefits to implementation increased whilst barriers reduced. Attitudes regarding NCPT implementation were conflicting.

Conclusions

Over three years, improvements were evident in NCPT knowledge, attitudes and usage. However, not all dietitians saw reason to implement NCPT in their practice, and some attitudes have become less supportive. A collective vision is required to foster positive attitudes towards the transformational professional benefits possible from NCPT. With ongoing uptake of electronic health records, the potential for NCPT to evaluate and justify dietetic interventions is increasing.     

Dietetics in Australia and New Zealand, May 1983: expanding professional horizons

This is a report on the author's activities and impressions of the dietetic profession in Australia and New Zealand, during a professional visit in May 1983. Activities included presenting the Abbott Lecture to the Third Annual Conference of the Australian Association of Dietitians, speaking at several state dietetic association meetings, and presenting some seminars. Foodservice systems in several hospitals were observed. Impressions related to the diverse educational backgrounds of dietitians, the focus on clinical practice, and the extreme youthfulness of the profession in some states. The author also modified a post-graduate program at the University of New South Wales to assist dietitians to gain more knowledge in foodservice administration.     

Mixed methods research approach to the development and review of competency standards for dietitians

Aim: Competency standards support a range of professional activities, including the accreditation of university courses educating health professionals. Reviewing these standards is essential to ensure universities continue to produce well‐equipped graduates, who are able to meet the challenge of changing workforce requirements. This paper has two aims: (a) to provide an overview of the methodological approaches used for compilation and review of the Competency Standards for Dietitians and (b) to evaluate the Dietitians Association of Australia's Competency Standards and capture emerging and contemporary dietetic practice. Methods: A literature review of the methods used to develop competency standards for dietitians in Australia, including entry‐level, Advanced level and Dieticians Association of Australia Fellow competencies and other specific areas of competency, such as public health nutrition and nutrition education, is outlined and compared with other allied health professions. The mixed methods methodology used in the most recent review is described in more detail. Results: The history of Dietetic Competency Standards development and review in Australia is compared with Dietetic Competency Standards internationally and within other health professions in Australia. The political context in which these standards have been developed in Australia and which has determined their format is also discussed. The results of the most recent competency standards review are reported to highlight emerging practice in Australia. Conclusion: The mixed methods approach used in this review provides rich data about contemporary dietetic practice. Our view supports a planned review of all competency standards to ensure practice informs education and credentialing, and we recommend the Dietitians Association of Australia consider this in the future.     

Improving the image of the dietitian—a personal view

The image of the dietitian is frequently discussed but few systematic studies identify (a) how dietitians perceive themselves, or (b) how others perceive the profession. This paper does not include a systematic study but includes a discussion which outlines some views on the evolution of the dietetic profession. Views are expressed on the science of dietetics, the unique role of the dietitian and professional image. One aim for the future should be to develop a post-graduate academic college of dietetics.     

Advancing practice: Using nutrition information and technology to improve health—the nutrition informatics global challenge

Aims: The unique combination of technology, information and nutrition has been utilised in health care for decades. As technology and effective use of health data evolve, the field of ‘nutrition informatics’ is positioned to advance best practices of nutrition care delivered by registered dietitians and dietetic technicians registered. The present paper reviews the opportunities. Methods: A narrative review was constructed with reference to the literature. Results: Evolution of the use of digital health care in the USA is on an aggressive timeline because of regulations, which provide financial incentives to eligible professionals and hospitals who can prove ‘meaningful use’ of certified health‐care technology. While adoption and use of electronic health records has occurred at the international level for decades, only recently have American adoption rates increased. Health‐care providers are adjusting to rapid cultural changes, which support the interoperability of health data. The dietetics profession must move in tandem with this transition to digital care. This requires implementation and development of nutrition standards, vocabularies and quality measures, which support exchange of pertinent nutrition data critical to patient care and wellbeing. All dietetic professionals need to appreciate the paradigm shift in health care. Conclusions: Dietitians who are involved with informatics will help with this transition through their work with systems implementations, understanding competencies necessary for successful integration of digital nutrition and using electronic nutrition data for research.     

Expediting medical record charting by use of adhesive labels

The use of adhesive labels in nutrition care charting has increased the documentation of registered dietitians and dietetic technicians in the medical record of each patient. At least to some extent, this improvement can be attributed to adhesive labels overcoming several "roadblocks" to charting. Credit for improvement must also be attributed to increased emphasis placed on charting throughout the dietetics profession. Increased charting has contributed to a more prominent role for the registered dietitian and dietetic technician in the daily care of the patient. Emphasis must continue on the quality of charting. Goals include reports that have a professional appearance and are concise yet contain pertinent details for patient care and reimbursement.     

Communication competence within dietetics: dietitians' and clients' views about the unspoken dialogue – the impact of personal presentation

Background:  Although client communications are affected by clients' assumptions about professionals' characteristics drawn from dress attire, little is known about how this dialogue operates in dietetics. The present study aimed to describe how dietitians and their clients interpret this dialogue and to explore the implications for practice.
Methods:  A purposive quota sample of dietitians ( n  = 46) from 21 health services in one state of Australia and a quota of their adult patients ( n  = 34) were interviewed about dietitians' nutrition education roles. Semi-structured interviews were transcribed and identified themes developed into a questionnaire to survey Australian dietitians. Analysis used frequencies and nonparametric statistics ( P  <0.05). Triangulation of the results obtained from the studies revealed a strong agreement between data sources.
Results:  Dietitians' dress attire was perceived as a key source of nonverbal communications by dietetics clients. This was recognised by 75% of the 256 dietitians who were surveyed nationally. Dietitians favoured a professional style (i.e. skirt or slacks, with top). Many clients rejected formal dress (i.e. suit, high heels) as being a potential communication barrier. Some clients viewed dietitians' bodily size/shape as a role model. Implications of dietitians' presentation (i.e. how you look) were important to both clients and dietitians.
Conclusion:  Dress style is implicated in nonverbal communication dialogues between the dietitian and client. As a matter of competence and to maintain congruency in communication, dietitians should be aware of their clients' preferences for formality of dress, and conduct their attire accordingly.     

Dietitians and supervision: should we be doing more?

As the role of the dietitian has expanded over recent years, many are becoming increasingly involved in the care and management of vulnerable individuals, both alone and as part of multidisciplinary teams. This raises an important question – how are we as a profession managing our changing role in the health care setting? The advent of Clinical Governance means there is a need for dietitians to join the debate on the issue of supervision, which has been raging in the nursing and other health professions over recent years. This article attempts to define the terms supervision and clinical supervision both globally and in the context of dietetics, to describe models of clinical supervision being used in other professional groups and to put forward a framework for addressing whether there is a need for clinical supervision in all areas of dietetic practice.     

The Next Generation of Dietitians: Implementing Dietetics Education and Practice in Integrative Medicine

Integrative medicine is a quickly expanding field of health care that emphasizes nutrition as a key component. Dietitians and nutritionists have an opportunity to meet workforce demands by practicing dietetics and integrative medicine (DIM). The purpose of this article is to describe a DIM education program and practicum. We report the results of an interprofessional nutrition education and practicum program between the University of Kansas Medical Center (KUMC) Department of Dietetics and Nutrition and KU Integrative Medicine. This partnered program provides training that builds on the strong foundation of the Nutrition Care Process and adds graduate-level educational and practicum experiences in foundational integrative medicine knowledge, including nutritional approaches from a systems biology perspective, nutrigenomics, and biochemistry as the core knowledge to understand the root cause of a chronic disorder and to choose appropriate nutritional tools for interventions. This interprofessional KUMC program provides a dietetic internship, master's degree, and graduate certificate in DIM and fulfills a need for dietitians and nutritionists who seek careers practicing in an integrative medicine setting. The program fulfills expanding workforce needs to provide quality health care for patients with chronic illnesses.     

Future Dietitian 2025: informing the development of a workforce strategy for dietetics

Background

Healthcare is changing and the professions that deliver it need to adapt and change too. The aim of this research was to inform the development of a workforce strategy for Dietetics for 2020–2030. This included an understanding of the drivers for change, the views of stakeholders and recommendations to prepare the profession for the future.

Methods

The research included three phases: (i) establishing the context which included a literature and document review (environmental scan); (ii) discovering the profession and professional issues using crowd‐sourcing technology; and (iii) articulating the vision for the future using appreciative inquiry.

Results

The environmental scan described the current status of the dietetic profession, the changing healthcare environment, the context in which dietitians work and what future opportunities exist for the profession. The online conversation facilitated by crowd‐sourcing technology asked the question: ‘How can dietitians strengthen their future role, influence and impact?’ Dietitians and interested stakeholders (726 and 109, respectively) made 6130 contributions. Seven priorities were identified and fed into the appreciative inquiry event. The event bought together 54 dietitians and analysis of the discussions generated five themes: (i) professional identity; (ii) strong foundations‐creating structure and direction for the profession; (iii) amplifying visibility and influence; (iv) embracing advances in science and technology; and (v) career advancement and emerging opportunities.

Conclusions

A series of recommendations were made for the next steps in moving the workforce to a new future. The future for dietetics looks bright, embracing technology, as well as exploring different ways of working and new opportunities, as this dynamic profession continues to evolve.

     

Current dietetic practices of obesity management in Saudi Arabia and comparison with Australian practices and best practice criteria

Aim:  To describe the dietetic practices of the treatment of obesity in Saudi Arabia and compare this with best practice criteria and the practice in Australia.
Methods:  Anonymous questionnaires were completed by dietitians in Saudi Arabia. The topics included barriers to obesity management, demand and level of service and strategies and approaches used for weight management. Best practice scores were based on those used to assess Australian dietitians.
Results:  A total of 253 dietitians participated in the survey. Of these, 175 (69%) were involved in the management of obesity. The best practice score for Australian dietitians was slightly greater than the scores of Saudi dietitians (median 43 vs 39). There was also a significant correlation between the best practice score and years of experience (r = 0.26, P < 0.001). The most common assessment approaches were assessment of body mass index (87%) and exercise habits (81%), while the most common strategies for obesity management were: dietary total fat reduction (92%) and increase incidental daily activity (92%). The major barrier for establishment of a weight management clinic reported by 49% of participants was inadequate resources.
Conclusion:  Saudi Arabian dietetic practice for the management of obesity does incorporate most best practice recommendations, but some specific elements are rarely used.     

Conceptualizing Professionalism in Dietetics: An Australasian Qualitative Study

BackgroundProfessionalism is a vital aspect of health care and multidisciplinary teamwork. Although there is substantive professionalism literature in medicine and an expanding health care professions literature, there is a significant gap in understanding professionalism in dietetics. There are very few research papers in the dietetics literature on this issue compared with other health professions. Given the multidisciplinary nature of health care, it is important to understand what professionalism means within each profession to develop shared understandings across health care teams.ObjectiveThe study aim was to explore how dietetics professionalism is conceptualized by dietetic practitioners/preceptors, faculty, and new graduates.DesignA constructionist exploratory qualitative interview study was conducted.Participants/settingOne hundred participants (dietetics graduates, faculty, and practitioners/preceptors), associated with 17 universities across Australia and New Zealand and from diverse geographical and work settings, participated in 27 group and 24 individual interviews from March 2018 to June 2019.Statistical analyses performedThematic framework analysis was used to examine participants’ understandings of professionalism.ResultsTwenty-three dimensions of dietetics professionalism were identified, with the most common being communication and including four novel dimensions of professionalism (generational, emotion management, cultural capability, and advocacy) not previously described in other professions. Professionalism as emotion management and generational adds new insights to the professionalism literature, expanding understandings of this vital aspect of health care. Although high levels of consistency in professionalism understandings existed across the three stakeholder groups, some interesting differences were found. The profession of dietetics shares similarities with other professions in the ways professionalism is conceptualized.ConclusionsUsing these dimensions of professionalism as a framework for teaching and learning about professionalism will help in clarifying expectations and expand shared understandings about professionalism for dietitians, other health professions, and across multidisciplinary teams.     

What's cooking for dietetics? A review of the literature

Aim: There are issues surrounding the apparent decline and devaluing of cooking skills in the population, potential health impacts and the role of dietitians. The present paper aims to outline several arguments and raise questions on the relationship between cooking and dietetics. Methods: Evidence from dietetics and nutrition journals and other sources is used to develop positions for dietetics and its relationship to cooking and cooking skills Results: The historical relationship between dietetics and home economics has seen dietetics professionally distance itself by its scientific education on food and nutrition, rather than actual involvement with cooking. In pursuing this rational scientific approach there are concerns that dietitians have inadvertently supported the growth of the functional and convenience food market, particularly given the demise of home economics as a skill-based curricula in schools in several states. There is a need to consider what role cooking skills could have in dietetics training as a professional competency for practice, particularly for public health interventions. This is in the light of Commonwealth government funding that is legitimising cooking skill interventions as a policy response to obesity. There may be a role for dietitians to develop partnerships and train a new professional category or paraprofessionals and/or peer educators to deliver cooking skill interventions Conclusion: There is a need for research on dietitian's views and use of cooking skill interventions. This would help answer whether we should consider cooking and cooking skills as part of our professional practice and whether cooking should be a dietetic competency.     

A look at the educational preparation of the health-diagnosing and treating professions: do dietitians measure up?

Basic educational requirements for dietitians were developed almost 80 years ago and remain largely unchanged. In the interim, other health professions have increased their academic standards. A review of the educational preparation of 16 health-diagnosing and treating professions was undertaken to better understand the standards for dietetics education within a larger context. Educational standards for each profession were obtained and reviewed for types of degrees; duration of post-secondary, college-level education; division of didactic and clinical education; and presence of accredited post-professional education. Findings reveal that at least 11 of the professions studied offer first professional degrees. Differences were noted in duration and sequencing of undergraduate education, didactic or classroom education, and especially supervised practice. Models to facilitate comparison between educational standards were developed. The current educational model in dietetics is designed to prepare entry-level practitioners and academics who comprise less than 20% of the profession. This review supports the need to investigate educational opportunities for beyond-entry-level dietitians, and to develop educational programs that amplify the existing models for educating dietitians.